Telehealth Visits After a Connecticut License Expired
Dr. B holds a Connecticut chiropractic license and a New York license. Her Connecticut license expired on March 31 because she completed only part of the required continuing education. She received a renewal notice but assumed a grace period applied. In May she began treating four Connecticut residents by secure video: two established patients with chronic low back pain and two new patients with neck pain. She reviewed imaging uploaded by one new patient and recommended a home traction unit. She told staff to schedule 'as usual' and that her renewal was 'pending.' No Connecticut license is currently active. She has not been disciplined before. Her malpractice insurance is current and covers telehealth. One new patient asks whether the video visit is 'covered by Connecticut license.'
1. Did Dr. B practice lawfully in May? Analyze both her license status and the location rule for telehealth.
Read the worked answer
No. A pending renewal is not an active license, and an expired license does not authorize practice while the application is processed. Connecticut regulates practice where the patient is located, so a video visit with a patient physically in Connecticut is practice in Connecticut even if Dr. B is sitting in New York. Reviewing uploaded imaging, taking a new-patient history, recommending a traction unit, and scheduling follow-up are clinical acts, not administrative exceptions. The two new patients make the problem clearer because new-patient evaluation and treatment planning are core chiropractic services. Dr. B should have verified her Connecticut status before the first May visit. The lawful position is that she must hold an active Connecticut license or fall within a specific statutory exception; 'my renewal is pending' is not an exception.
2. What must Dr. B do to return to lawful practice, and what should she tell the patients already seen?
Read the worked answer
She should stop all Connecticut patient care immediately, complete the outstanding continuing education, submit the renewal or reinstatement application with the required fee and any late fee, and confirm in writing that the license status is active before seeing another Connecticut patient. She should preserve the records of the four May visits and not alter them. She should contact the patients, explain that her Connecticut license was not active during those visits, offer referrals to licensed Connecticut providers, and avoid billing for the unlawful visits or arrange refunds. She should not characterize the visits as fully covered by Connecticut license. If she believes a patient needs urgent follow-up, she should arrange a handoff rather than continue treating. She should also notify her malpractice carrier if required by the policy.
3. If the Department of Public Health opens a complaint, what aggravating and mitigating facts would likely matter?
Read the worked answer
Aggravating facts include continuing to treat after a renewal notice, treating new patients rather than only established ones, using the misleading phrase 'pending' when no active license existed, and seeing four patients over multiple dates. Those facts suggest more than a clerical oversight. Mitigating facts include no prior discipline, current malpractice coverage, a prompt self-correction once challenged, completion of the missing continuing education, cooperation with the investigation, and patient notification with referrals. The board would also consider whether any patient was harmed and whether Dr. B attempted to conceal the lapse. A likely disciplinary outcome could include a reprimand, probation, a civil penalty, continuing education, and a requirement to verify license status before practice. Unlicensed practice is a serious charge because it affects every patient seen during the lapse.